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General NPI Number Information
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NPI Number | 1588657779
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Entity Type | Individual
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Provider Name | ROBERT BOLTUCH MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 440-423-1356
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Fax |
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Provider Business Mailing Address
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Address Line | 3605 WARRENSVILLE CENTER ROAD MSC 9152
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122
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Country | US
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Telephone | 216-286-6299
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Fax | 216-286-6341
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35038688
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License Number State | OH
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